WBR0374: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pharmacology
|MainCategory=Pharmacology
Line 20: Line 20:
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Renal
|SubCategory=Renal
|Prompt=A 72 year old Caucasian male patient presents to the emergency department complaining of hematuria and back pain of recent onset. The patient’s past medical history is significant for hypertension controlled on pirindopril and diabetes mellitus type II controlled on metformin.  Physical examination is significant for a palpable abdominal mass.  After appropriate initial work-up, renal biopsy is performed and shows the findings in the image below.  If surgical intervention is not possible, which of the following pharmacologic therapies is the best treatment modality for the patient’s condition?
|Prompt=A 72-year-old Caucasian male presents to the ER with complaints of hematuria and back pain. The patient’s medical history is significant for hypertension, controlled with pirindopril, and diabetes mellitus type II, controlled with metformin.  Upon physical examination you observe a palpable abdominal mass.  After appropriate initial work-up, you preform renal biopsy (the findings are displayed in the image below).  If surgical intervention is not possible, which of the following pharmacological therapies is the best treatment modality for the patient’s condition?


[[Image:Renal clear cell carcinoma.png|500px]]
[[Image:Renal clear cell carcinoma.png|500px]]
|Explanation=Renal cell carcinoma, commonly clear cell carcinoma, is a malignant kidney cancer that originates in the proximal convoluted tubule.  In localized disease, partial and radical nephrectomy are both treatment options depending on the size of the tumor.  Approximately 30% of patients with renal cell carcinoma are initially diagnosed with metastatic disease.  While conventional cancer therapy is not effective, cytokine recombinant interleukin-2, aldesleukin, has demonstrated clinical efficacy.  
|Explanation=[[Renal cell carcinoma]], also termed clear cell carcinoma, is a malignant kidney cancer originating in the proximal convoluted tubule.  In a localized tumor, partial or radical nephrectomy are treatment options, depending on the size of the tumor.  Approximately 30% of patients with [[renal cell carcinoma]] are initially diagnosed with [[metastatic disease]].  While conventional cancer therapy is typically ineffective, [[cytokine recombinant interleukin-2]], ([[aldesleukin]]), has demonstrated clinical efficacy.  


New therapeutic options, including vascular endothelial growth factor (VEGF) inhibitors and mammalian target of rapamycin pathways have also been showing clinical effectiveness and may be therapeutic options for patients with metastatic renal carcinoma.
New therapeutic options, such as vascular endothelial growth factor (VEGF) inhibitors and mammalian target of rapamycin pathways, have also demonstrated clinical effectiveness in treating patients with metastatic renal carcinoma.


Educational Objective:
|EducationalObjective=[[Cytokine recombinant interleukin-2]], ([[aldesleukin]]), has demonstrated to be an effective pharmacologic therapy for patients with advanced renal cell carcinoma.
Aldesleukin, interleukin 2 recombinant cytokine, has been shown to be an effective pharmacologic therapy for patients with advanced renal cell carcinoma.


Reference:
|Reference= Rini, BI, Campbell SC, Escudier B.  Renal cell carcinoma. The Lancet.  2009; 373(9669):1119-1132
Rini, BI, Campbell SC, Escudier B.  Renal cell carcinoma. The Lancet.  2009; 373(9669):1119-1132
|AnswerA=Folic acid analog that inhibits dihydrofolate reductase
|AnswerA=Folic acid analog that inhibits dihydrofolate reductase
|AnswerAExp=Methotrexate, an antimetabolite is not an effective treatment for renal clear cell carcinoma.  Methotrexate is commonly used for hematologic malignancies.
|AnswerAExp= [[Methotrexate]], an antimetabolite, is not an effective treatment for renal clear cell carcinoma.  [[Methotrexate]] is frequently used to treat hematologic malignancies.
|AnswerB=Pyrimidine analog that inhibits DNA polymerase
|AnswerB=Pyrimidine analog that inhibits DNA polymerase
|AnswerBExp=Similar to methotrexate, cytarabine, also an antimetabolite, is not effective in renal cell carcinoma.
|AnswerBExp= [[Cytarabine]], an antimetabolite, is not effective in the treatment of renal cell carcinoma.
|AnswerC=Alkaloid that blocks polymerization of microtubule in the M phase
|AnswerC=Alkaloid that blocks polymerization of microtubule in the M phase
|AnswerCExp=Microtubule inhibitors, such as vincristine and vinblastine, may be used Wilms’ tumor and Hodgkin’s lymphoma.
|AnswerCExp= Microtubule inhibitors, such as [[vincristine]] and [[vinblastine]], may be used to treat [[Wilms tumor]] and [[Hodgkins lymphoma]].
|AnswerD=Calcineurin inhibitor that binds to FK-binding protein
|AnswerD=Calcineurin inhibitor that binds to FK-binding protein
|AnswerDExp=Tacrolimus is a calcineurin inhibitor that binds to FK-binding protein.  It is commonly used as an immunosuppressive agent for renal transplant recipients.
|AnswerDExp= Tacrolimus, a calcineurin inhibitor that binds to FK-binding protein, is commonly used as an immunosuppressive agent for renal transplant recipients.
|AnswerE=Immune modulation by interleukin-2 recombinant therapy
|AnswerE=Immune modulation by interleukin-2 recombinant therapy
|AnswerEExp=Aldesleukin, interleukin 2 recombinant cytokine, is an effective pharmacologic therapy for patients with advanced renal cell carcinoma.
|AnswerEExp= Aldesleukin (interleukin 2 recombinant cytokine) is an effective pharmacological therapy for patients with advanced renal cell carcinoma.
|RightAnswer=E
|RightAnswer=E
|Approved=No
|Approved=Yes
}}
}}

Revision as of 17:35, 16 July 2014
Author [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology
Sub Category SubCategory::Renal
Prompt [[Prompt::A 72-year-old Caucasian male presents to the ER with complaints of hematuria and back pain. The patient’s medical history is significant for hypertension, controlled with pirindopril, and diabetes mellitus type II, controlled with metformin. Upon physical examination you observe a palpable abdominal mass. After appropriate initial work-up, you preform renal biopsy (the findings are displayed in the image below). If surgical intervention is not possible, which of the following pharmacological therapies is the best treatment modality for the patient’s condition?

]]

Answer A AnswerA::Folic acid analog that inhibits dihydrofolate reductase
Answer A Explanation [[AnswerAExp::Methotrexate, an antimetabolite, is not an effective treatment for renal clear cell carcinoma. Methotrexate is frequently used to treat hematologic malignancies.]]
Answer B AnswerB::Pyrimidine analog that inhibits DNA polymerase
Answer B Explanation [[AnswerBExp::Cytarabine, an antimetabolite, is not effective in the treatment of renal cell carcinoma.]]
Answer C AnswerC::Alkaloid that blocks polymerization of microtubule in the M phase
Answer C Explanation [[AnswerCExp::Microtubule inhibitors, such as vincristine and vinblastine, may be used to treat Wilms tumor and Hodgkins lymphoma.]]
Answer D AnswerD::Calcineurin inhibitor that binds to FK-binding protein
Answer D Explanation AnswerDExp::Tacrolimus, a calcineurin inhibitor that binds to FK-binding protein, is commonly used as an immunosuppressive agent for renal transplant recipients.
Answer E AnswerE::Immune modulation by interleukin-2 recombinant therapy
Answer E Explanation AnswerEExp::Aldesleukin (interleukin 2 recombinant cytokine) is an effective pharmacological therapy for patients with advanced renal cell carcinoma.
Right Answer RightAnswer::E
Explanation [[Explanation::Renal cell carcinoma, also termed clear cell carcinoma, is a malignant kidney cancer originating in the proximal convoluted tubule. In a localized tumor, partial or radical nephrectomy are treatment options, depending on the size of the tumor. Approximately 30% of patients with renal cell carcinoma are initially diagnosed with metastatic disease. While conventional cancer therapy is typically ineffective, cytokine recombinant interleukin-2, (aldesleukin), has demonstrated clinical efficacy.

New therapeutic options, such as vascular endothelial growth factor (VEGF) inhibitors and mammalian target of rapamycin pathways, have also demonstrated clinical effectiveness in treating patients with metastatic renal carcinoma.
Educational Objective:
References: ]]

Approved Approved::Yes
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